Abscess of liver

Abscess of the liver . Piogenic abscesses after widespread use of antibiotic therapy have become a rare disease. Occur as a result of an ascending biliary infection; Hematogenous spread of infection through the portal venous system or through the hepatic artery in sepsis; Direct spread of infection in inflammatory diseases of the abdominal cavity; Liver injury. In most cases, liver abscesses are a complication of severe, often purulent, cholangitis, which occurs with cholelithiasis or cancer of extrahepatic bile ducts. Other causes are sepsis, pilephlebitis, which can be a complication of destructive appendicitis, colon diverticulitis, ulcerative colitis.

Pyogenic abscesses can be single, but more often there are multiple abscesses. A single abscess is more often located in the right lobe.

Bacterial flora in the abscess is found in about 50% of cases. When sepsis is more often sown golden Staphylococcus aureus, hemolytic streptococcus, with biliary abscesses, an intestinal wand or a mixed flora is more often found. In recent years, much attention has been paid to anaerobic flora, which can be detected only when sowing pus on a special medium.

Symptoms, course. Abscess of the liver is always a secondary disease. On the background of clinical manifestations of the underlying disease, the temperature acquires intermittent or hectic character, chills, sweating, nausea, and appetite decrease. Pain is a late symptom and is more common in single large abscesses. The liver is often enlarged and the tenderness of its edge appears during palpation. Sometimes there is an ichthyosis of the skin and a sclera. In the analysis of blood - high leukocytosis with a shift of the formula to the left, anemia. When sowing blood, the causative agent of the disease is detected in about 30%, more often with abscesses of septic origin. With a review of fluoroscopy of the abdominal cavity, a high standing and limited mobility of the right dome of the diaphragm are detected, possibly a fluid accumulation in the pleural sinus. With gassing flora on the background of the shadow of the liver can determine the level of fluid, sometimes a deformation of the upper contour of the liver. Diagnostics is assisted by ultrasound examination of the liver, computer X-ray tomography, angiography, as well as liver scanning with technetium-99.

Treatment. Antibiotic therapy in accordance with the sensitivity of microflora. To create a larger concentration of antibiotic in the liver, it is possible to insert a catheter into the hepatic artery (by Seldinger) or into the umbilical vein after its isolation and instrumental bougie for dilatation. With single large or several large abscesses, surgical treatment is indicated - opening and draining of the abscess. Access-laparotomy or thoraco-laparotomy. The most sparing and at the same time effective method of treatment (especially with multiple abscesses) is percutaneous drainage of the abscess under the control of a computer tomograph or an ultrasound scanner.

Complications: sepsis, sub-diaphragmatic abscess, breakthrough abscess in the free abdominal or in the pleural cavity, empyema of the pleura, purulent pericarditis.

The forecast is always very serious. When single large abscesses in the case of timely drainage, up to 90% of patients recover. Multiple abscesses and undrained solitary almost always lead to death.